Faculty Opinions recommendation of Determination of brain death/death by neurologic criteria: the world brain death project.

2020 ◽  
Author(s):  
Luciana Mascia ◽  
Anna Teresa Mazzeo
Keyword(s):  
Brain Death ◽  
The World ◽  
World Brain ◽  
Death By Neurologic Criteria

Barriers to the Use of Neurologic Criteria to Declare Death in Africa

2021 ◽  
pp. 104990912110069
Author(s):  
Ariane Lewis ◽  
Andrew Kumpfbeck ◽  
Jordan Liebman ◽  
Sam D. Shemie ◽  
Gene Sung ◽  
...  
Keyword(s):  
Brain Death ◽  
Legal Framework ◽  
Developing Regions ◽  
Healthcare Facilities ◽  
Life And Death ◽  
The World ◽  
Religious Perspectives ◽  
World Brain ◽  
The Creation ◽  
Death By Neurologic Criteria

There are varying medical, legal, social, religious and philosophical perspectives about the distinction between life and death. Death can be declared using cardiopulmonary or neurologic criteria throughout much of the world. After solicitation of brain death/death by neurologic criteria (BD/DNC) protocols from contacts around the world, we found that the percentage of countries with BD/DNC protocols is much lower in Africa than other developing regions. We performed an informal review of the literature to identify barriers to declaration of BD/DNC in Africa. We found that there are numerous medical, legal, social and religious barriers to the creation of BD/DNC protocols in Africa including 1) limited number of healthcare facilities, critical care resources and clinicians with relevant expertise; 2) absence of a political and legal framework codifying death; and 3) cultural and religious perspectives that present ideological conflict with the idea of BD/DNC, in particular, and between traditional and Western medicine, in general. Because there are a number of unique barriers to the creation of BD/DNC protocols in Africa, it remains to be seen how the World Brain Death Project, which is intended to create minimum standards for BD/DNC around the world, will impact BD/DNC determination in Africa.

Determination of death by neurologic criteria around the world

Neurology ◽  
2020 ◽  
Vol 95 (3) ◽  
pp. e299-e309 ◽  
Author(s):  
Ariane Lewis ◽  
Azza Bakkar ◽  
Elana Kreiger-Benson ◽  
Andrew Kumpfbeck ◽  
Jordan Liebman ◽  
...  
Keyword(s):  
Brain Death ◽  
Drug Clearance ◽  
Noxious Stimulation ◽  
Pupillary Reflex ◽  
Cough Reflex ◽  
Medical Standards ◽  
The World ◽  
The Face ◽  
Death By Neurologic Criteria

ObjectiveTo identify similarities and differences in protocols on determination of brain death/death by neurologic criteria (BD/DNC) around the world.MethodsWe collected and reviewed official national BD/DNC protocols from contacts around the world between January 2018 and April 2019.ResultsWe communicated with contacts in 136 countries and found that 83 (61% of countries with contacts identified, 42% of the world) had BD/DNC protocols, 78 of which were unique. Protocols addressed the following prerequisites and provided differing instructions: drug clearance (64, 82%), temperature (61, 78%), laboratory values (56, 72%), observation period (37, 47%), and blood pressure (34, 44%). Protocols did not consistently identify the same components for the clinical examination of brain death; 70 (90%) included coma, 70 (90%) included the pupillary reflex, 68 (87%) included the corneal reflex, 67 (86%) included the oculovestibular reflex, 64 (82%) included the gag reflex, 62 (79%) included the cough reflex, 58 (74%) included the oculocephalic reflex, 37 (47%) included noxious stimulation to the face, and 22 (28%) included noxious stimulation to the limbs. Apnea testing was mentioned in 71 (91%) protocols; there was variability in the technique and target across protocols. Ancillary testing was included as a requirement for all determinations of BD/DNC in 22 (28%) protocols.ConclusionsThere is considerable variability in BD/DNC determination protocols around the world. Medical standards for death should be the same everywhere. We recommend that a worldwide consensus be reached on the minimum standards for BD/DNC.

Contentious Ethical and Legal Aspects of Determination of Brain Death

2018 ◽  
Vol 38 (05) ◽  
pp. 576-582 ◽  
Author(s):  
Ariane Lewis
Keyword(s):  
United States ◽  
Brain Death ◽  
The United States ◽  
Legal Aspects ◽  
Determination Of Death ◽  
The World ◽  
Death By Neurologic Criteria ◽  
Role Of Religion

AbstractAlthough the concept of death by neurologic criteria is accepted throughout much of the world and death can legally be determined by neurologic criteria throughout the United States, the process is fraught with contentious ethical and legal controversies. I explore historic and contemporary ethical and legal disputes about determination of death by neurologic criteria including the need for consent from patients' surrogates prior to determination of death, the role of religion in determination of death, management of objections to determination of death by neurologic criteria, the approach to patients who are dead by neurologic criteria but are pregnant, and gamete retrieval after determination of death.

Determination of Brain Death/Death by Neurologic Criteria

JAMA ◽  
2020 ◽  
Vol 324 (11) ◽  
pp. 1078 ◽  
Author(s):  
David M. Greer ◽  
Sam D. Shemie ◽  
Ariane Lewis ◽  
Sylvia Torrance ◽  
Panayiotis Varelas ◽  
...  
Keyword(s):  
Brain Death ◽  
Death By Neurologic Criteria

Author Response: Determination of Death by Neurologic Criteria Around the World

Neurology ◽  
2021 ◽  
Vol 96 (17) ◽  
pp. 827.2-827
Author(s):  
Ariane Lewis ◽  
Sam D. Shemie ◽  
Gene Sung ◽  
Sylvia Torrance ◽  
David Greer
Keyword(s):  
Author Response ◽  
Determination Of Death ◽  
The World ◽  
Death By Neurologic Criteria ◽  
Response Determination

scholarly journals An interdisciplinary response to contemporary concerns about brain death determination

Neurology ◽  
2018 ◽  
Vol 90 (9) ◽  
pp. 423-426 ◽  
Author(s):  
Ariane Lewis ◽  
James L. Bernat ◽  
Sandralee Blosser ◽  
Richard J. Bonnie ◽  
Leon G. Epstein ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Brain Death ◽  
American Academy ◽  
Determination Of Death ◽  
Brain Death Determination ◽  
Death By Neurologic Criteria ◽  
Law And Humanities ◽  
American Academy Of Neurology ◽  
Death Determination

In response to a number of recent lawsuits related to brain death determination, the American Academy of Neurology Ethics, Law, and Humanities Committee convened a multisociety quality improvement summit in October 2016 to address, and potentially correct, aspects of brain death determination within the purview of medical practice that may have contributed to these lawsuits. This article, which has been endorsed by multiple societies that are stakeholders in brain death determination, summarizes the discussion at this summit, wherein we (1) reaffirmed the validity of determination of death by neurologic criteria and the use of the American Academy of Neurology practice guideline to determine brain death in adults; (2) discussed the development of systems to ensure that brain death determination is consistent and accurate; (3) reviewed strategies to respond to objections to determination of death by neurologic criteria; and (4) outlined goals to improve public trust in brain death determination.

Ontology II: From World–Brain Relation to Consciousness

2018 ◽  
pp. 269-314
Author(s):  
Georg Northoff
Keyword(s):  
Body Problem ◽  
Structural Realism ◽  
The World ◽  
World Brain ◽  
The One ◽  
Definition Of ◽  
The Mind ◽  
Physical Features ◽  
The Brain

How can we account for the existence and reality of consciousness and mental features in general? The present chapter complements the previous one by shifting the focus from the ontological determination of the brain to consciousness. I characterized the brain’s existence and reality by world-brain relation for which I presupposed relation and structure as basic units of existence and reality. This entails structural realism, that is, ontic structural realism (OSR). I now apply the definition of the brain by world-brain relation and OSR to consciousness. The main point is that I extend the spatiotemporal definition of world-brain relation to consciousness, that is, its phenomenal features as distinguished from neuronal (and physical) features (while leaving out other features of consciousness like cognitive features; chapter 7). Specifically, I argue that the world-brain relation provides the necessary non-sufficient ontological condition of possible consciousness, the “ontological predisposition of consciousness” (OPC) as I say. The world-brain relation is characterized by spatiotemporal structure with relational time and space which makes possible “upward spatiotemporal entailment” of consciousness. Accordingly, consciousness is entailed spatiotemporally by world-brain relation; this, in turn, makes possible necessary (rather than contingent) a posteriori ontological connection between brain and consciousness on the basis of their commonly underlying and shared world-brain relation. Importantly, this makes superfluous the introduction of the concept of mind to account for necessary connection of mental features to their underlying ontological basis. Therefore, I suggest replacing the concept of mind by the one of world-brain relation. This entails that the mind-body problem becomes superfluous and can be replaced by what I describe as “world-brain problem”.

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